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https://ir.cnu.edu.tw/handle/310902800/30999
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| 標題: | Establishing predictors for successfully planned endotracheal extubation |
| 作者: | Lai, Chih-Cheng
Chen, Chin-Ming
Chiang, Shyh-Ren
Liu, Wei-Lun
Weng, Shih-Feng
Sung, Mei-I
Hsing, Shu-Chen
Cheng, Kuo-Chen |
| 貢獻者: | Chi Mei Med Ctr, Dept Intens Care Med
Chi Mei Med Ctr, Dept Intens Care Med
Chi Mei Med Ctr, Dept Internal Med
Dept Chia Nan Univ Pharm & Sci
Kaohsiung Med Univ, Dept Healthcare Adm & Med Informat
Chung Hwa Univ Med Technol, Dept Safety Hlth & Environm Engn |
| 關鍵字: | extubation
mechanical ventilation
predictor |
| 日期: | 2016-10 |
| 上傳時間: | 2018-01-18 11:39:33 (UTC+8) |
| 出版者: | Lippincott Williams & Wilkins |
| 摘要: | The aim of this study was to establish predictors for successfully planned extubation, which can be followed by medical personnel. The patients who were admitted to the adult intensive care unit of a tertiary hospital and met the following criteria between January 2005 and December 2014 were collected retrospectively: intubation > 48hours; and candidate for extubation. The patient characteristics, including disease severity, rapid shallow breath index (RSBI), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), cuff leak test (CLT) before extubation, and outcome, were recorded. The CLT was classified as 2+ with audible flow without a stethoscope, 1+ with audible flow using a stethoscope, and negative (N) with no audible flow, even with a stethoscope. Failure to extubate was defined as reintubation within 48hours. In total, 6583 patients were enrolled and 403 patients (6.1%) had extubation failures. Male patients dominated the patient cohort (4261 [64.7%]). The mean age was 64.516.3 years. The overall in-hospital mortality rate was 11.3%. The extubation failure rate for females was greater than males (7.7% vs 5.3%, P<0.001). The group of patients who failed extubation were older (66.7 +/- 14.4 vs 64.3 +/- 16.4, P = 0.002), had higher APACHE II scores (16.8 +/- 7.6 vs 15.9 +/- 7.8, P = 0.023), lower coma scales (10.3 +/- 3.7 vs 10.8 +/- 3.7, P = 0.07), a higher RSBI (69.9 +/- 37.3 vs 58.6 +/- 30.3, P<0.001), a lower MIP, and MEP (-35.6 +/- 15.3 vs -37.8 +/- 14.6, P = 0.0001 and 49.6 +/- 28.4 vs 58.6 +/- 30.2, P<0.001, respectively), and a higher mortality rate (25.6% vs 10.5%, P<0.001) compared to the successful extubation group. Based on multivariate logistic regression, a CLT of 2+ (odds ratio [OR] = 2.07, P<0.001), a MEP 55cmH(2)O (OR = 1.73, P<0.001), and a RSBI<68breath/min/ml (OR = 1.57, P<0.001) were independent predictors for successful extubation.This study identified 3 independent risk factors for successful extubation after a successful breathing trial, including a CLT of 2+, a MEP 55cmH(2)O, and a RSBI < 68breath/min/ml. Furthermore, a nomogram integrating these 3 parameters, which represented the combined consideration of the upper airway patentency, cough strength, and respiratory capacity, was developed to better predict extubation success. |
| 關聯: | Medicine, v.95 n.41, e4852 |
| 顯示於類別: | [通識教育中心] 期刊論文
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